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From the 7/16/2021 release of VAERS data:

Found 479,813 cases where Vaccine is COVID19 and Patient Did Not Die



Case Details (Reverse Sorted by Onset Date)

This is page 202 out of 4,799

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VAERS ID: 1374502 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-06-02
Onset:2021-06-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Arthralgia, Bone pain, Chills, Ear pain, Eye pain, Headache, Hyperhidrosis, Myalgia, Nausea, Night sweats, Pain, Pain in extremity, Pyrexia, Spinal pain, Suppressed lactation
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Eosinophilic pneumonia (broad), Osteonecrosis (broad), Functional lactation disorders (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prenatal vitamin (for nursing), sunflower lecithin, St. John?s wort
Current Illness: N/a
Preexisting Conditions: Mild asthma
Allergies: N/a
Diagnostic Lab Data:
CDC Split Type:

Write-up: I had fever of 99? after taking ibuprofen 600 mg throughout the day on June 3. I had chills and sweats alternating from the evening and throughout the night. I woke up completely drenched in sweat I had to change my clothes. The chills were so severe that I could barely move (also because my bones hurt). All of this was over the course of approximately 6 PM until the next morning around 5 AM. More significantly, I experienced severe bone, joint and muscle aches all throughout my body. I had severe pain especially in my ankles, feet and knees. I also experienced pain in my spine, hands, arms, stomach, ears, and eyes. I felt mild nausea and a very mild headache. I am also nursing an infant, and my milk production was reduced from 30 ounces a day to approximately 15 ounces on the day of June 3.


VAERS ID: 1374513 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Loss of consciousness, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Pt w/ hx of allergy to Amoxicillin (anaphylaxis, lip/face swelling).
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt w/ hx of allergy to Amoxicillin (anaphylaxis, lip/face swelling). Pt c/o dizziness at 1410. Pt had a syncopal episode for a few seconds and woke up when reclined. Patient is A/O x4. Patient is cooperative, and denies pain or SOB. VS taken at triage, BP 86/54, HR 60, O2 97, RR 20, Temp 97.3. CN, nurse, and onsite provider were notified. Pt reports sweating, but denies tremor, numbness, tingling, nausea or vomiting. Offered juice and cracker to pt, no new medication ordered. VS repeated at 1420, BP 111/93, HR 85, O2 97, RR 16. pt reports improvement and denies dizziness, pt left triage with steady gait with family at 1430 and have further observation. Pt left clinic with family. Pt was advised to seek for emergency service if s/s worsen. All needs met, safety maintained.


VAERS ID: 1374636 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: New York  
Vaccinated:2021-03-24
Onset:2021-06-03
   Days after vaccination:71
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3302 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chronic obstructive pulmonary disease, Cough, Dyspnoea, SARS-CoV-2 test positive, Vaccine breakthrough infection, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Diltiazem, rivaroxaban, Trelegy Ellipta, baclofen, ferrous sulfate, sertraline, albuterol neb, aspirin, Rocklatan, furosemide, spironoloactone, APAP-oxycodone #3, allopurinal, calcium + vitamin D, tadalafil, tiotropium, budesonaide-formoter
Current Illness:
Preexisting Conditions: CAD , HTN, DVT , Asthma, Hiatal hernia , afib, HFpEF, abdominal wall hematoma, anxiety/depression, COPD, chronic atrial fibrillation, restless leg syndrome, HTN
Allergies: Azithromycin IV only, enalapril maleate
Diagnostic Lab Data: SARS-CoV-2 test positive on 6/3
CDC Split Type:

Write-up: Patient contracted COVID-19 after receiving two COVID-19 vaccine doses (Pfizer series completed on 3/24/21). Patient was admitted to the hospital for cough and wheezing and diagnosed with COPD exacerbation. Her COVID PCR was negative on 5/22 and 6/1 and then positive on 6/3. Patient now with cough and increasing SOB requiring 3L NC.


VAERS ID: 1374642 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Anxiety, Chest discomfort
SMQs:, Anaphylactic reaction (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Complaints of anxiety and chest tightening


VAERS ID: 1374651 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Rhode Island  
Vaccinated:2021-05-01
Onset:2021-06-03
   Days after vaccination:33
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: School       Purchased by: ?
Symptoms: Hepatomegaly, Liver function test normal, Platelet count decreased
SMQs:, Liver related investigations, signs and symptoms (narrow), Haematopoietic thrombocytopenia (narrow), Systemic lupus erythematosus (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Banophen 25mg, Zyrtec 10mg, Flonase, Zaditor opthalmic solution, Vitamin D 2000u capsule
Current Illness: Chronic ITP
Preexisting Conditions: Chronic ITP (diagnosed in 2016)
Allergies: Pollen
Diagnostic Lab Data:
CDC Split Type:

Write-up: 15yo with Chronic ITP (since 2016) came to hematology clinic for routine follow-up and was noted to have palpable hepatomegaly on exam. LFT''s were within normal limits. Patient reported possible scleral icteris but denied any abdominal pain. No splenomegaly. Did not pursue imaging as it would not change management and had normal LFTs. Platelet count was 104,000 prior to vaccine and 134,000 2 weeks after vaccine. She will return to our clinic on 6/22, 5 days after her 2nd dose of Pfizer vaccine to reassess labs and hepatomegaly.


VAERS ID: 1374657 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt w/ syncopal episode and dizziness approximately 10 mins after vaccination. BP 105/59, HR 72, RR 16 -- $g 110/68, 81. Pt was hydrated and released by provider. Pt was alert and oriented, speaks in full complete sentences, VSS. No facial/mandible/tongue swelling. NO stridor. Pt feeling better. Ambulated with steady gait. Released from vaccination site with parents. Instructed to follow w/ PMD.


VAERS ID: 1374667 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Alaska  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cough, Dizziness, Dyspnoea, Heart rate increased, Hypertension, Throat irritation
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Hypertension (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Claritin D; Omprezole 40 mg; Vitamin D3, Vitamin C
Current Illness: Positive COVID 19 test on April 16, 2021.
Preexisting Conditions: Seasonal allergies
Allergies: Antibiotics except sulfa drugs, and ciproflaxin
Diagnostic Lab Data: Walmart provided 25mg liquid benedryl; one epi pen shot. EMT gave epi injection.
CDC Split Type:

Write-up: Dizziness, rapid heart rate, high blood pressure; throat ?burning?; intense coughing, lessened ability to breathe.


VAERS ID: 1374669 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Immediate post-injection reaction, Nervousness, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt c/o dizziness immediately after receiving 2nd dose of Pfizer. Pt had one episode of syncope. Father was present and assisted pt to the ground. No falls. Pt reports feeling nervous. A&Ox3. pt speaks in full complete sentences. No facial/mandible/tongue swelling. No stridor. Pt ambulatory to med bay, refusing to sit in w/c, w/ steady gait. Pt refusing pulse oximeter. Resp regular/deep. BP stable 149/50, HR 88, RR 16. Pt tol PO. Pt stable and released from the vaccination site. Recommended that the patient follow up w/ their healthcare provider.


VAERS ID: 1374713 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-01
Onset:2021-06-03
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain, Myocarditis, Troponin increased
SMQs:, Myocardial infarction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data: 6/4 high sensitivitiy troponin 5500
CDC Split Type:

Write-up: chest pain and developed myocarditis starting 2 days after receiving 2nd covid vaccine


VAERS ID: 1374732 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: "1:26pm- 15y/o male reported he was feeling dizziness and was brought to the observation room. Pt vomited a small amount. 1:28pm - Pt was transferred to bed. VSS and WNL. BP 111/71, HR 83, RR 24. Pt had no prior hx of dizziness, vomiting after vaccination. Pt was checked by MD. No Resp distress, allergic rxn to vaccination was observed. Pt drank 16oz water and reported feeling better. 1:39pm - Second vitals 111/70, HR 84, RR 20. Pt walked around the room w/ PA and was communicating w/ father & RN. 1:41pm Pt stable and released from the vaccination site with father."


VAERS ID: 1374739 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-06-02
Onset:2021-06-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Cough, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: doctor''s office visit
CDC Split Type:

Write-up: within 18 hours, child began with cough and wheezing, requird albuterol treatments wheezing persisted for 40 hours


VAERS ID: 1374743 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Palpitations, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D 5000 IU once a week Valacyclovir 1 gm as needed. Trazadone 50mg nightly as needed
Current Illness: none
Preexisting Conditions: IBS Hyperlipidemia Herpes labialis
Allergies: none
Diagnostic Lab Data: 6/3/21 diphenhydramine 25mg cap, oral hydration and discharged home from urgent care.
CDC Split Type:

Write-up: patient experienced throat getting tight and closing, lightheadedness ,palpitations. oxygen administered, rapid response called and patient taken to Urgent care on site for treatment and monitoring.


VAERS ID: 1374744 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: New York  
Vaccinated:2021-03-30
Onset:2021-06-03
   Days after vaccination:65
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8733 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Abortion spontaneous, Exposure during pregnancy, Inappropriate schedule of product administration
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Termination of pregnancy and risk of abortion (narrow), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown - answered none to screening question on 3/30/2021 (first shot Pfizer) and again on second dose 5/16/2021.
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown - answered no to screening question both vaccination dates
Diagnostic Lab Data: None Known
CDC Split Type:

Write-up: Patient received a two dose series of Pfizer /BioNTech vaccine. First dose March 30 , 2021 and second dose May 16, 2021. She answered no to all questions including no to pregnancy at both occurrences. There were no requests at either times for a medical evaluator to answer additional questions. The patient returned to the vaccination POD on June 3rd, 2021 claiming that she had a miscarriage some time after the second dose. She requested information about the POD but did not offer any other information. She requested that we advise people that this happened to her and that she has already alerted the local news agencies and CDC.


VAERS ID: 1374745 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Pt w/ hx of lactose intolerance. Pt w/ medical hx for anxiety and depression.
Allergies: Pt w/ hx of lactose intolerance
Diagnostic Lab Data:
CDC Split Type:

Write-up: "Pt w/ hx of lactose intolerance. Pt w/ medical hx for anxiety and depression. 12:20 - 15yo Female reported feeling nausea 10 min after vaccination. Pt was taken to observation room. Vitals BP 129/85, HR 86, RR 20. Pt vomited for a few mins. 12:30 - pt reported relief after vomiting. no signs of resp distress, dizziness, flushing was observed. Pt is communicating w/ Physician and is stable. Pt given water 8oz. 12:36pm - BP 101/70, HR 87, RR 16. 12:50pm - Pt stable and released from the vaccination site with mother."


VAERS ID: 1374748 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027C21A / 1 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Extra dose administered, Interchange of vaccine products, No adverse event
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aspirin (OTC) 81mg, potassium chloride, Eliquis, atorvastatin, Lasix, metoprolol tartrate, Eucerin cream, potassium chloride
Current Illness: None
Preexisting Conditions: Atrial Fibrillation, hearing loss, pneumonia/admission
Allergies: No known allergies
Diagnostic Lab Data: No Medical tests ordered by attending physician. Resident not showing any adverse reactions.
CDC Split Type:

Write-up: The patient has not had any adverse reaction to the Moderna Dose. The patient was given the dose in error. Patient had already received the Pfizer vaccine series. Dose 1 was administered on 2/1/2021 and Dose 2 was administered on 2/22/2021. Patient physician was notified of error. Patient is being monitored for 72 hours for vitals and signs and symptoms of any adverse reactions. Attending physician did not order any Medical test.


VAERS ID: 1374753 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Inappropriate schedule of product administration
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: none
CDC Split Type:

Write-up: After vaccination upon documenting, it was realized that vaccine was given 14 days from 1st dose, rather than 221 days.


VAERS ID: 1374760 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-05-26
Onset:2021-06-03
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site pain, Injection site pruritus, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: patient received moderna vaccine on 5/26/21 and said there was a little redness around the injection site since that time but that it just got bigger on 6/3/21...there is redness, warmth, itching, burning to the area around the injection site in a circular pattern. patient is going to go to her pcp and informed her to take benadryl and uses cold compresses in the mean time


VAERS ID: 1375025 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Dry mouth, Headache, Nausea, Pain in extremity, Paraesthesia
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tendinopathies and ligament disorders (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: High blood pressure
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Tingling in arm, arm sore to touch, dry mouth, nauseous, headache


VAERS ID: 1375026 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chills, Exposure during pregnancy, Headache, Pain, Pain in extremity, Pyrexia, Tremor, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prenatal, omega fish oil supplements
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: I''m pregnant, due in the middle of November. I got my second covid19 vaccine and about 9 hours later I started having symptoms. I had a sore arm right away but over night I had headaches, body aches, chills, slight fever, and vomiting. I couldn''t stop shaking and I couldn''t keep anything down. I am a little over 24 hours out from the shot and still have the symptoms, except vomiting has decrease and might have stopped.


VAERS ID: 1375038 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Cold sweat, Flushing, Hyperhidrosis, Hypotension, Impaired driving ability, Nausea, Pallor, Syncope, Vision blurred, Visual impairment
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Flushed / Sweating-Mild, Systemic: Hypotension-Medium, Systemic: Nausea-Mild, Systemic: Visual Changes/Disturbances-Medium, Systemic: Weakness-Medium, Additional Details: pt. appeared to have an episode of syncope. Could not see vision went blurry, was sweaty and clammy to touch, skin went pale, felt a little nauesous, blood pressure was 84/46. I had him sit down and put his head between his legs. I spoke to Nurse at Dr. office. She advised he go the ER. I retook his blood pressure and it went up to 122/83. Vision came back and was not clammy. He still felt weak and skin color started to become normal. His mother came and took him to the ER.


VAERS ID: 1375066 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood test, Headache, Paraesthesia, Somnolence, Unresponsive to stimuli
SMQs:, Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: seizure disorder history of synecope
Allergies: Tylenol, Zipro, Codeine, Valium, Advair, Hydrocodone, Nortriptyline, crabmeat, lobster
Diagnostic Lab Data: Per Hospital, receive 1 liter of fluids and had bloodwork done. Released from hospital to home at1813.
CDC Split Type:

Write-up: Reported he walked to health department from home. After administration of vaccine, complained of tingling in right hand and wrist at 1544. Drank some bottled water. Complained of feeling sleepy and a headache. Began nodding off and then became unresponsive. BP at 1600: 98/78. Pulse: 80. BP at 1607: 100/70. Pulse: 72. Was beginning to rouse around this time but drowsy. Respirations 16. BP at 1615: 86/60. 911 called. Taken to hospital via ambulance at 1628.


VAERS ID: 1375070 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-06-01
Onset:2021-06-03
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Extra dose administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 67 year old male arrives at vaccination clinic for administration of first dose. Patient was oriented about the vaccination process, possible side effects after getting the first dose and advised about the date and the process for receiving the second shot. Vaccination process was uneventful. 2 days later, the coordinators and medical director was contacted by municipal epidemiologist informing the patient received a third shot of the vaccine. After reviewing the documents presented by the municipal official, in fact the patient was vaccinated in another clinic, but the vaccination card has missing information such as incomplete name, unknown facility. Also, the previous 2 doses were not registered in the online database.


VAERS ID: 1375072 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-02
Onset:2021-06-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033B21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pruritus, Rash, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None documented
Current Illness: None documented
Preexisting Conditions: None documented
Allergies: No documented allergies
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Skin became itchy day after vaccination leading to itchy rash over body 2 days after vaccination. Patient advised to take Benadryl and contact PCP in regards to allergic reaction. No indication of trouble breathing or worsening rash at time of documentation.


VAERS ID: 1375078 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022B21A / 3 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Extra dose administered, No adverse event
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: FACILITY ASKED US TO VACCINATE THEIR RESIDENTS AND SAID THIS PATIENT HAD NO PREVIOUS DOSES OF COVID VACCINE THEY CONTACTED US TODAY TO SAY THEY HAD MADE AN ERROR AND PATIENT HAD PREVIOUSLY RECEIVED TWO DOSES OF MODERNA COVID 19 VACCINE. THIS WAS NOW THE THIRD DOSE GIVEN TO THE PATIENT WE RECORDED THIS ADMINISTRATION AND REPORTED EVENT. CLINIC WILL MONITOR PATIENT SO FAR NO ADVERSE EFFECTS


VAERS ID: 1375107 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-21
Onset:2021-06-03
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Product administered at inappropriate site, Rash
SMQs:, Anaphylactic reaction (broad), Drug abuse and dependence (broad), Hypersensitivity (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ALLEGRA ASMANEX NASACORT
Current Illness:
Preexisting Conditions: ASTHMA DYSMENNORHEA
Allergies: ASPARTAME CEFDINIR AMOXICILLIN
Diagnostic Lab Data: none
CDC Split Type:

Write-up: This is a rash on her left arm encircling this spot check the vaccine Covid 19 and she had the vaccine 1 week ago in the retroperitoneum a day or 2 of that and is now fading away


VAERS ID: 1375123 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009C21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Headache, Sciatica, Somnolence
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received second dose on day 22. I spoke to patient at 2:40 on 6/4 and she is reporting sciatica, headache and has been sleeping all day. She said she had COVID and was in the hospital for 11 days and her symptoms started with sciatica.


VAERS ID: 1375129 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-02-04
Onset:2021-06-03
   Days after vaccination:119
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Ageusia, Bell's palsy, Dry eye, Facial paralysis
SMQs:, Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Corneal disorders (broad), Hearing impairment (broad), Conjunctival disorders (narrow), Lacrimal disorders (narrow), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Famotidine, sertraline 100mg, levothyroxine 100mcg, loratadine, multivitamins
Current Illness: None
Preexisting Conditions: Herpes simplex 2
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Bells Palsy (loss of taste, dry eye, acute facial paralysis on right side of face)


VAERS ID: 1375143 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-04
Onset:2021-06-03
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / -

Administered by: Public       Purchased by: ?
Symptoms: Bone pain, Chills, Fatigue, Nausea
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Osteonecrosis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Quetiapine Adderall Gabapentin
Current Illness: Bipolar Disorder OCDC
Preexisting Conditions: Same as above
Allergies: Pine nuts
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Bone Aches, extreme fatigue, chills, nausea starting about 12:30 pm on June 3, 2021 and continued throughout night. Fatigue on June 4, 2021. Second dose of COVID shot administered May 4,2021.


VAERS ID: 1375156 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER 1821288 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Wellbutrin
Current Illness: Asthma
Preexisting Conditions: Asthma, depression
Allergies: Asthma
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hives and rash, given antihistamines


VAERS ID: 1375258 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021B21A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, No adverse event
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patients wife Came in to health Dept for patients second dose but dud not have his card. Dose administered in car per patients request. Wife returned card into health Dept. Patient had received first Covid Vaccine on 5-25-2021. patient then received second covid vaccine on 6-3-2021. No Side effects noted on 6-3-2021 and patient was contacted on 6-4-2021 and spoke to his wife and informed Health department he was doing fine.


VAERS ID: 1375260 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011D21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Malaise, Pain, Pyrexia, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient called this morning around 9:00 am. She states that since getting her covid vaccination yesterday, she feels really sick. Fever/achy and she is having facial swelling. She said she didn''t feel like this after the first dose. Since facial swelling is an abnormal and dangerous side effect, I recommended she go to the ER (or at least an urgent care) to be evaluated immediately because she doesnt want the facial swelling to get worse or extend to her breathing. She stated at that time she was having no trouble with her throat or breathing. She said she was going to go to the ER. I told her in the meantime she could take liquid benadryl while on her way to the ER


VAERS ID: 1375266 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Nausea
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PT REPORTS NAUSEA THEN CRACKERS WAS GIVEN AFTER THAT N/V STOPPED 02 99%


VAERS ID: 1375283 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: No adverse event, Product administered to patient of inappropriate age
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none known
Preexisting Conditions: none known
Allergies: none known
Diagnostic Lab Data: none known
CDC Split Type:

Write-up: Patient''s mother, falsified form noting daughter''s date of birth as 1/15/2009 and age as 12. Her correct date of birth is 11/15/2009 and her correct age is 11. We did not discover this until billing the vaccination, at which time the vaccination had already been administered. No adverse reaction has been reported at this time.


VAERS ID: 1375286 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Decreased appetite, Dizziness
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PT REPORTS DIZZINESS CLAIMS DID NOT EAT. LATER CRACKER AND WATER WAS GIVEN REPORTED FINE.


VAERS ID: 1375291 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-03-08
Onset:2021-06-03
   Days after vaccination:87
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6206 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Dyspnoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Tested POSITIVE for COVID on 6/3/2021 - SOB


VAERS ID: 1375311 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-06-02
Onset:2021-06-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Burning sensation, Erythema, Ocular hyperaemia, Swollen tongue
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Peripheral neuropathy (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Glaucoma (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: swelling of her tongue. She only has swelling to the left side of her tongue. Redness and burning of her face and bilateral eye redness


VAERS ID: 1375340 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-02-06
Onset:2021-06-03
   Days after vaccination:117
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test positive
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: positive PCR covid test
CDC Split Type:

Write-up: tested POSITIVE for COVID on 6/3/2021 after being fully vaccinated.


VAERS ID: 1375347 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dizziness, Hyperhidrosis, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt felt feverish and lightheaded within 5 minutes of vaccine. He experienced sweating and chills. Administered one dose of acetaminophen. Pt was monitored for 30 minutes and felt better prior to leaving. We followed up later in the day and he did not experience any further symptoms.


VAERS ID: 1375365 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Dyspnoea, Interchange of vaccine products, Pruritus
SMQs:, Anaphylactic reaction (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Medication errors (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: First covid shot was moderna. Patient called a short time after pfizer shot that she was having some intermittent SOB and had to use an inhaler. Also stated she had some itching without a rash. At a 24 hr follow up symptoms had become milder and not resolved. Patient also has hx of asthma.


VAERS ID: 1375378 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-01
Onset:2021-06-03
   Days after vaccination:33
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Arteriogram coronary normal, Electrocardiogram ST segment elevation, Myocarditis, Troponin increased
SMQs:, Myocardial infarction (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Crestor
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Elevated troponin ECG with st elevation Normal coronary anatomy by angiography
CDC Split Type:

Write-up: Myocarditis


VAERS ID: 1375579 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anxiety, Tremor, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received her first dose of the Pfizer vaccine at 2:27PM and was under observation for 30 minutes. Patient did not report any symptoms/side effects while under observation and left the facility when her 30-minute period was up. Patient returned to Building with her spouse at approximately 3:10PM with tremors and reported feeling anxious because she believed the vaccine needle was still in her arm. Our team reassured her that this wasn?t the case, the RN explained that we use retractable needles for safety reasons, and we asked the patient to stay for additional observation. At approximately 3:35PM, patient?s spouse called for assistance because patient was not responding. Patient was assessed by our MD lead and was unresponsive to verbal stimuli but responsive to physical stimuli; BP was within normal limits. MD lead and spouse escorted patient to ED via wheelchair at approximately 3:45PM for further evaluation.


VAERS ID: 1375601 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt w/ Syncope and dizziness. BP 115/71, HR 65, RR 12 -- $g 115/68, 73. Pt stable and released from the vaccination site.


VAERS ID: 1375609 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Tennessee  
Vaccinated:1993-11-20
Onset:2021-06-03
   Days after vaccination:10057
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Vaccine was accidentally given outside of the 6 hour expiration date after the vial was opened.


VAERS ID: 1375613 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt c/o dizziness, taken to room for observation, VSS. BP 105/73, HR 101, RR 16 -- $g 106/67, 75, 16. Pt given fluids. Upon reassessment, pt denied nausea and dizziness, assisted pt to sitting position. No distress noted. Pt stable and discharged from vaccination site in mother''s care.


VAERS ID: 1375620 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Paraesthesia oral
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lexipril Spironolactone
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Penicillin
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Approximately 15mins. after receiving 2nd dose PT. c/o "tingling"to her lips. PT. moved to treatment area where she was assessed and vitals and history obtained. PT. denied any other symptoms other than the tingling. PT. given 25mg of Benadryl and observed. After approximately 20mins. pt. stated the tingling had subsided. PT. vitals taken again and PT. observed another 10mins. PT. released with her mother and both were advised to seek further medial attention or call 911 with any further problems.


VAERS ID: 1375623 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Vaccine was given outside of the expiration window when the vial was first opened.


VAERS ID: 1375633 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Unknown  
Location: Tennessee  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: The vaccine was accidentally given outside of the expiration window once the vial was opened.


VAERS ID: 1375635 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Hypoaesthesia, Palpitations
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: no known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: At 1:30 patient with heart palpitations. Patient verbalized " I feel my heart skipping". Denies chest pain, shortness of breath. Slight dizziness noted. No change in LOC. Denied nausea and vomiting. Patient assisted to gurney in sitting position. Patient was given water and snacks as requested. 1:33pm - vital signs monitored - v/s signs BP - 165/80, pulse - 81, RR - 18 & 02 sat - 99% RA 1:45pm - Patient felt numbness on Left arm, patient refused to have vital signs taken again x3. 911 was called per patients request 1:52pm - paramedics came to evaluate patient & sent to hospital for further evaluation


VAERS ID: 1375636 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, No adverse event
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none known
Preexisting Conditions:
Allergies: none known
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient unknowingly came into pharmacy for a second dose of Covid-19 vaccination 8 days early. His first vaccine was not given at Walgreens and so there was no record of it in our system. When filling his vaccine card after giving the dose, I realized that his first dose was on his vaccine card was dated on 5/14/21. He had just received his second dose on 6/3/21 which is 20 days (instead of 28 days) after the first dose of Moderna Covid-19 Vaccine. Patient showed no signs of adverse reaction after 30 minutes following vaccination. The incident will be reported to Walgreens for further investigation.


VAERS ID: 1375639 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Lip discolouration
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient c/o dizziness, no SOB, no LOC, alert & verbal, no n/v, no pain/discomfort. Patient assisted to gurney in supine position with HOB elevated. Pt given water/ vital signs monitored BP 106/91 pulse-81, RR - 17, ~2 sat - 98%, RA 2:50pm - patient verbalized relief from dizziness, no SOB, no headache, no n/v, alert & verbal, lip color returned back to normal, no LOC. Vital signs BP 108/77, pulse - 91, RR - 17, 02 Sat 98% RA


VAERS ID: 1375641 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Vaccine was accidentally given outside of the expiration date window once the vial was opened.


VAERS ID: 1375642 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Paraesthesia oral, Swelling face, Swelling of eyelid, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: norco for joint pain
Current Illness:
Preexisting Conditions:
Allergies: penicillin, chocolate
Diagnostic Lab Data:
CDC Split Type:

Write-up: Initial Evaluation: Throat tightening for few seconds only. Swelling on face near eye, tingling on lips Patient is alert and responsive. Refused to call 911, she stated she felt better. BP 149-91 Pulse: 82 02 96%. Given oral benadryl capsule 25 mg. Patient feels better, throat tightening resolved, little swelling on right side of face on right eyelid. Alert and oriented x4, no shortness of breath, no chest pain. Patient advised to go to the ER for further evaluation. Patient agrees to go to the ER but refused to go via nonemergent ambulance or 911. Patient prefers to go by herself to the ER. Refused to call ambulance.


VAERS ID: 1375644 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Pallor
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient felt dizzy about 10 minutes after receiving the vaccine. Patient was alert, oriented, and responsive but her skin looked pale in color. Patient was assisted to lay down on the exam table. No fainting or near syncopal episode noted. Vital signs were taken and were stable. Patient was offered a water bottle to drink. Patient laid down on the exam table for a bout 10 minutes and left in a stable condition.


VAERS ID: 1375647 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C21A / 2 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046B21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Fatigue, Influenza like illness, Injection site swelling, Injection site urticaria, Oropharyngeal pain, Pyrexia, Throat irritation
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Apple cider vinegar gummies, multivitamin
Current Illness: None
Preexisting Conditions: Fibromyalgia, costochondritis, degenerative disc disease
Allergies: Penicillin, Lyrica, sensitive to capsaicin,
Diagnostic Lab Data: None so far.
CDC Split Type:

Write-up: Dose 1 - itchy throat 45 minutes post vaccine. Sore throat about 3 hours post vaccine. Mild fever, fatigue, flu like symptoms began 22 hours post vaccine and lasted about 24 hours. ***** Day 8 developed "Covid arm". Hive like swelling at injection site. Mildly swollen for about 18 hours, then flattered and began to shrink in size. No trace after 4 days. Vaccine 2 has been reported to V-safe, so follow up will continue there.


VAERS ID: 1375658 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Cold sweat, Fatigue, Psoriasis, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Nobe
Current Illness:
Preexisting Conditions: PsA and plaque psoriasis
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Continued joint soreness, low grade fever, fatigue, clammy, plaque psoriasis continuing to flare up after a year of none!


VAERS ID: 1375664 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-06-02
Onset:2021-06-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 2 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Lymphadenopathy, Pain, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Isibloom oral contraceptive, lexapro 40mg daily, pepcid 20 mg as needed, zyrtec 10 mg daily, over the counter omega-3, turmeric, and multivitamin
Current Illness:
Preexisting Conditions:
Allergies: Omnicef, peanuts, tree nuts
Diagnostic Lab Data:
CDC Split Type:

Write-up: Around 12 am after the dose of my vaccine, I got a fever, chills, body aches, headache and fatigue. I knew all of these things to be normal. My arm was sore and I also knew that was expected. I could hardly move out of bed. At 0700 this morning, on 6/4, I finally got the energy to shower. That is when I noticed my lymph node in my armpit of the same arm I received my vaccine in was swollen to about the size of a tennis ball. I had a PA that I work with recommend me to go to an urgent care to be seen because she did not believe this to be normal. I received a Toradol injection and a course of antibiotics to take in case it turned out to be infected.


VAERS ID: 1375700 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Vermont  
Vaccinated:0000-00-00
Onset:2021-06-03
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Headache
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210607371

Write-up: HEADACHES; This spontaneous report received from a patient concerned a 29 year old female. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: 042A21A, expiry: UNKNOWN) dose was not reported, administered on 29-MAY-2021 for prophylactic vaccination. No concomitant medications were reported. On 03-JUN-2021, the subject experienced headaches. The action taken with covid-19 vaccine was not applicable. The patient had not recovered from headaches. This report was non-serious.


VAERS ID: 1375808 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-02
Onset:2021-06-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO168 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ear pain, Headache, Myalgia, Pain, Urticaria
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: sulfa-based meds give me hives
Diagnostic Lab Data:
CDC Split Type:

Write-up: Besides the body ache, headache, and sore muscles, I had bad earaches and hives. the hives have gotten worse on the second day and keep spreading around. i''ve tried to take an antihistamine, but I''m not sure if it''s working. I am waiting another day or two before heading to the doctors but I wanted to report the EARACHES and HIVES.


VAERS ID: 1375814 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-06-01
Onset:2021-06-03
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Insomnia
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Asthma, psoriasis
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Insomnia


VAERS ID: 1375836 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-02
Onset:2021-06-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Atrioventricular block first degree, Chest pain, Electrocardiogram ST segment elevation, Electrocardiogram abnormal, Pyrexia, SARS-CoV-2 antibody test, Sinus arrhythmia, Sinus rhythm, Troponin increased
SMQs:, Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Disorders of sinus node function (narrow), Conduction defects (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None known
Current Illness:
Preexisting Conditions: Developmental delay, sinus bradycardia
Allergies: Penicillin
Diagnostic Lab Data: Troponin elevated to 10.82 SARS-CoV-2 IgG Ab - negative EKG: Sinus rhythm with sinus arrhythmia with 1st degree AV block. ST elevation, probably due to early repolarization.
CDC Split Type:

Write-up: Patient received vaccine on 6/2. On 6/3 developed low grade fever to 100.6F, later endorsed his "heart hurting." Initially presented to outside hospital ED.


VAERS ID: 1375856 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-06-02
Onset:2021-06-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea, Dyspnoea, Fatigue, Feeding disorder, Malaise, Nausea, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Desmopressin, fioricet, aimovig
Current Illness: Possible sinus infection
Preexisting Conditions: Migraines Diabetes insipidus
Allergies: Amoxicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Difficulty breathing starting ~24 hours after, lasted around 24 hours; Nausea starting ~16 hours after, still happening Diarrhea starting ~24 hours after, still happening; Fatigue and malaise ~12 hours after, still happening; Unable to drink/eat more than Gatorade and Electrolites without vomiting.


VAERS ID: 1375910 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-05-27
Onset:2021-06-03
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C21A / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Erythema, Peripheral swelling, Pruritus, Swelling
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Rabies
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Latex
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Redness, swelling, and itching in right arm and axilla.


VAERS ID: 1375916 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-02
Onset:2021-06-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Axillary pain, C-reactive protein, C-reactive protein normal, Chest pain, Electrocardiogram, Electrocardiogram normal, Fatigue, Full blood count, Full blood count normal, Injection site pain, Injection site swelling, Troponin, Troponin normal
SMQs:, Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: No known allergies
Diagnostic Lab Data: 6/4/2021: Obtained Troponin, CBC, CRP to evaluate for myocarditis/pericarditis. Normal EKG in clinic showing RSR with HR of 62 and no ectopics or ST segment changes. 6/4/2021 @ 1322: Labs return showing normal Troponin, normal CBC, and normal CRP. Discussed via phone with Doctor. He recommends repeat in 12 hours or alternatively watch/wait and only intervene further if any symptoms occur. Discussed on phone with mom who elects at this time for no further intervention. She was made to feel comfortable contacting me at any time if any concerns arise.
CDC Split Type:

Write-up: After second dose of Pfizer Covid-19 vaccine he received two days ago on Wednesday June 2nd around 5pm. Felt tired that night and into the next day with some local swelling and pain to the right arm at site of injection, and also into right armpit. Thursday evening, he was resting sitting on the couch and developed some mild chest pain. Can''t really describe the location or severity very well. Did seem to be worse with inspiration. Hasn''t reoccurred since that time. Still feels somewhat tired today with mildly sore right arm. No fevers. No chest pain today. IR showed second dose of Pfizer Covid-19 vaccine was given to the left arm but confirmed with CVS that it was given to the right arm.


VAERS ID: 1375929 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Fatigue, Headache, Nausea, Slow speech, Tension
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: hypertension and currently takes Atenolol and Losartan
Current Illness: hypertension and currently takes Atenolol and Losartan
Preexisting Conditions: HTN
Allergies: "severe allergic reaction" to Bactrim and Sulfa and exhibits " anxiety and confusion
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: On Thursday, 6/3/2021, patient (DOB: 03/02/1985) received her second dose of Pfizer Covid-19 vaccine (LOT #: EW0187, exp.: on 8/2021) at 9:28 am on her left deltoid. During assessment questions, client states her underlying medical condition includes hypertension and currently takes Atenolol and Losartan. Client denied any other heart or respiratory diseases. Client also states she experiences "severe allergic reaction" to Bactrim and Sulfa and exhibits "anxiety and confusion" and requires a place to sit if standing for long period. At 10:00 am, while waiting in Observation Area, client stated to EMTs, "I''m feeling very tired." EMT''s responded immediately and provided a quiet environment and helped client in anti gravity chair. Vital signs were taken every 5 minutes. At 10:00 am: BP: 181/115 sitting, O2 sat: 99% with no respiratory distress noted, skin was warm to touch bilaterally, no skin rashes or swelling noted. Patient was alert, oriented X4 with clear, slow speech. At 10:07am, client was responsive to stimuli but was not verbally responsive with noted body guard; BP: 177/104 lying, HR: 56, O2sat: 99%. Upon further assessment, client complained of "the same 7/10 lower back pain that happened 3 weeks ago" and "feeling nauseous and fatigue". Client also stated she took her BP medications at 8:30 am. Client told the EMTs she did not follow up with her primary care provider after her first Pfizer dose. Client was also offered an ice pack to apply on her neck and encouraged to take deep breaths by EMT. At 10:15 am, BP: 201/121 lying, O2 sat: 99%, RR: 14, HR 59. Client was encouraged to drink water. At 10:17 am, client reported she felt "tension in the back of head and headache. Vitals: BP: 189/114 lying, HR: 67 bpm. Staff encouraged client to change positions in gravity chair for comfort however client reported "no improvement of the symptoms." EMT offered EMS service to which the client requested. At 10:22 am, EMS was activated by Lead RN. Client was educated by EMT and RN on signs and symptoms of adverse reactions and when to go to the ED/call MD. Client was also encouraged to sign-up on v-safe and importance of following up with her primary care physician. At 10:26 am, care was turned over to paramedics. At 10:30 am, client was verbally responsive, alert, oriented X4. Vitals: BP: 181/115 lying, HR: 80, O2 sat: 99%, Temp: 98.1. Client was transferred to a gurney with assistance from 4 AMR staff. At 10:36 am, client left facility to be transported to hospital for further assessment.


VAERS ID: 1375962 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-01
Onset:2021-06-03
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Bell's palsy
SMQs:, Hearing impairment (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: bells palsy 2 days after second dose


VAERS ID: 1375969 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / 6 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Loss of consciousness, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: PATIENT HAS PREVIOUSLY EXPERIENCED POTS SYNDROM/CONDITION - PAROXYSYMAL ORTHOSTATIC TACHYCARDIA
Preexisting Conditions: UNKNOWN - NO HISTORY OF ANY NEUROLOGICAL CONDITION - NOT ILL ON DAY OF VACCINATION - NO HISTORY OF ADVERSE REACTIONS TO PREVIOUS VACCINATIONS
Allergies: NONE
Diagnostic Lab Data: NONE -
CDC Split Type:

Write-up: Patient received vaccine with no apparent issue - sat in our waiting area per request for anticipated 15 minute + stay - Approximately 5 minutes after vaccination patient began to experience dizziness - elevated legs with chair with patient in sitting position - a minute later patient became unresponsive and appeared to have fainted/lost consciousness. Activated 911 system with local fire department and with patient not responsive - lifted patient from chair and placed on floor with cushion for head and elevated legs slightly - the patient had a pulse and was breathing the entire time and when able to communicate informed us she has a POTS condition - at this time EMT services arrived and stayed with patient for approximately 15 - 20 minutes talking the entire time - no transport to hospital - no drugs administered - patient may have followed up with walk-in/ER services but did not require transport and was released by EMT services


VAERS ID: 1375976 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Feeling abnormal, Hunger, Injection site bruising, Pain in extremity
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Dementia (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: daily multivitamin &zinc
Current Illness: none
Preexisting Conditions: none
Allergies: penicillin, vancomycin, lates, some tape [not paper]
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Janssen covid-19 vaccine EUA - side effects 1. head ''fog'' 2. voracious hunger [i''ve NE:VER had a flu vaccine] 21 hours in i''m still starving . what''s the cure? 15 hours later I woke up at 6 a.m. because I was starving I had to make myself eggs and toast. 17 hours " I had a bagel. 18 hours " I made meatballs I was eating them like candy. [albeit my meatballs are delish carmelized onions, roasted garlic, basil, pesto...yum] I feel drugged. [ it''s like a trip from the 70s flashback]. I feel weird. closest thing is dizzy but not dizzy just weird, very weird. head/brain fuzzy . The munchies continue. I never heard of these side effects before we''ll see how long they last. only a pale yellow bruise where the injection went in. minimal arm soreness if any , no rash. I got a 12-page booklet for taking the vaccine yesterday I''m going to report the symptoms to the CDC, Johnson & Johnson janssen and whoever else wants to hear about them there''s a big long list in the pamphlet they gave me. Maybe there''s a cure. I hope it doesn''t last too long I''ll run out of food. 6 hours later I''ve got the munchies I''m eating everything in sight for dinner I had soup, two salad,s a steak, dessert and pretzels. I''ve never eaten that much ever. 4 hours down I started getting super hungry but I thought it was cuz I barely ate breakfast and lunch cuz I didn''t know how this was going to react. I still don''t feel a thing in the arm. yay hope it sticks. I can''t even see where they gave me the shot. I will admit the shot did hurt a little when it went in, I don''t know if it''s cuz she pushed the plunger fast, or if it was cold from the refrigerator or what but I definitely felt a little something with it going in but not since. I realized that when I went into the hospital out building to get the vaccine I was talking to the nurse for a while because they had to go get my vaccine and she was telling me that three of her family members got the Johnson & Johnson and they didn''t feel a thing, no sore arm no fever no nothing so I''m hoping that subliminally I absorbed that and that''s why I''m having such a favorable results cuz I think I was really expecting something or other. Even though I know someone who got the jnj & didn''t have a problem. I did my own research and nobody under 50 has had a problem and even those people had medical conditions and we''re taking prescription drugs and so on which is not my case we''ll see. The first hour has passed no rash, no soreness of arm nothing I''m a little bit surprised happily.


VAERS ID: 1375997 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Inappropriate schedule of product administration
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown.
Current Illness: Not reported by client.
Preexisting Conditions: Unknown.
Allergies: Unknown
Diagnostic Lab Data: No additional test related at this time.
CDC Split Type:

Write-up: Per Employee, presented to Center stating he was here for his 2nd dose. Per Employee, she looked up the client on Vaccination system and the client did not have an appointment. Employee stated she looked at the back of the client''s vaccination card and noted that the card was not legible and damaged. Client was insistent that he was scheduled for his second dose today. Employee added client as a walk in for 2nd dose. Client proceeded to vaccination table with Vaccinator and Center. Client received received a 2nd dose of Pfizer COVID Vaccine (Lot#EW0187, EXP 06-28-2021) on 06-03-2021 at 1:15pm. Supervisor (myself) was notified by Lead that notified her that a client was added as a walk in for 2nd dose, but might have been too early. Supervisor determined name of client through participation forms and searched client on Vaccination system. RN reviewed vaccination system appointment and vaccination doses. On Vaccination system, client first dose documented on 05-22-2021 and second dose documented on 06-03-2021. Supervisor alerted Vaccinator that vaccinated client incorrectly. Supervisor reviewed vaccine administrations with inclusion of verifying client, DOB, right date, right time, right dose, right date, right route, and allergies with Vaccinator. Furthermore, Supervisor reviewed eligibility dates for Pfizer second dose. Supervisor reviewed with Ancillary the eligibility dates and the need to relay any concerns regarding vaccination cards, appointments, walk-in, and previous COVID-19 vaccinations prior to sending client in to get vaccinated to Lead or Lead Vaccinator. VERP completed. Site Coordinators alerted and event elevated for further evaluation.


VAERS ID: 1376000 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, No adverse event
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none known
Current Illness: none known
Preexisting Conditions: none known
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient stated he had never received covid vaccine and this was his first dose. I was later informed that he did receive both doses and that this was a third dose. No adverse events reported.


VAERS ID: 1376004 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-27
Onset:2021-06-03
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site rash, Injection site warmth, Nausea, Pyrexia, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Wellbutrin, Metropolol Tartrate, Tri-Lo
Current Illness: None
Preexisting Conditions: High blood pressure, depression, anxiety
Allergies: None
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Redness at injection site, and a red rash underneath that is warm to the touch and covers 1/3 of my upper arm. Also slight nausea and fever. Acetaminophen, and ice packs. So far, they''re not helping.


VAERS ID: 1376010 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Interchange of vaccine products
SMQs:, Medication errors (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient came in to receive the 2nd dose of the COVID vaccine, the consent form was not verified properly and vaccine was administered as the 2nd vaccination instead.


VAERS ID: 1376011 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Inappropriate schedule of product administration
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt received 2nd dose Pfizer one week early


VAERS ID: 1376023 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vaccine dose was given to the patient beyond-use-date. It was mixed at 4.05PM on 6/2/2021, left at room temperature in syringes and was given to the patient at 3:33PM on 6/3/2021.


VAERS ID: 1376030 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Interchange of vaccine products
SMQs:, Medication errors (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NA
Current Illness: NA
Preexisting Conditions: NA
Allergies: NA
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient is not having an adverse reaction, I am reported because she was mistakenly given Pfizer for dose 2 when she was supposed to receive dose 2 of Moderna. Moderna was administered on 5/13/21.


VAERS ID: 1376310 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Chills, Dizziness
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Dizziness / Lightheadness-Mild, Systemic: Felt very lightheaded/chills for about 30 minutes. Patient walked out along with her fiancee. she felt back to normal upon getting into they''re car.-Mild


VAERS ID: 1376314 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-14
Onset:2021-06-03
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Asthenia, Chest discomfort, Chest pain, Chills, Diarrhoea, Hypertension, Mobility decreased, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Abdominal Pain-Severe, Systemic: Chest Tightness / Heaviness / Pain-Severe, Systemic: Chills-Severe, Systemic: Diarrhea-Severe, Systemic: cannot move-Severe, Systemic: Hypertension-Medium, Systemic: Vomiting-Severe, Systemic: Weakness-Severe


VAERS ID: 1376327 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Muscular weakness, Pain, Rash, Rash pruritic, Skin burning sensation, Skin swelling
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Sertraline 100mcg Levothyroxine 100mg Prazosin 2mg Hydroxyzine 25mg (as needed)
Current Illness: None
Preexisting Conditions: Hypothyroidism, recently had ACL reconstruction
Allergies: None known
Diagnostic Lab Data: Spoke to the pharmacist and he advised Benadryl and hydrocortisone cream.
CDC Split Type:

Write-up: Painful raised/swollen skin on bicep. Burning,, itchy rash that spread over the next day but stayed localized to my upper arm. Extreme muscle weakness in left arm.


VAERS ID: 1376341 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-06-02
Onset:2021-06-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Eye swelling, Eyelid pain, Eyelids pruritus, Skin swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Latex, Augmentin, Bactrim
Diagnostic Lab Data:
CDC Split Type:

Write-up: Left eye is swollen and skin around the entire orbital socket, including eyelids, is tender and itchy


VAERS ID: 1376346 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-05-26
Onset:2021-06-03
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Angiogram, Chest pain, Dyspnoea, Electrocardiogram abnormal, Troponin normal, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Wellbutrin buspar lisinopril
Current Illness: none
Preexisting Conditions: anxiety
Allergies: bee venom Penicillin TDAP vaccine
Diagnostic Lab Data: neg CTA Troponin x2 neg. had T wave inversions and ST depression in anteriorlateral leads on ECG
CDC Split Type:

Write-up: urticarial rash w/ dermatographia, chest pain, SOB. started about 8 days after shot improving on steroids ECG abnormal w/ neg troponins x2. CTA of chest neg for clot or pneumonia was recently started on Buspar and wellbutrin 4 days prior to getting vaccine


VAERS ID: 1376395 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-06-02
Onset:2021-06-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820096 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye swelling, Mouth swelling, Pruritus, Rash, Swelling face, Swollen tongue
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Allergic: Itch (specify: facial area, extremeties)-Medium, Systemic: Allergic: Rash (specify: facial area, extremeties)-Medium, Systemic: Allergic: Swelling of Face / Eyes / Mouth / Tongue-Medium


VAERS ID: 1376402 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-05-21
Onset:2021-06-03
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Lymphadenopathy
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Claritin 10mg
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Cervical lymphadenopathy.


VAERS ID: 1376430 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: New York  
Vaccinated:2021-04-09
Onset:2021-06-03
   Days after vaccination:55
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 UN / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Activated partial thromboplastin time normal, Angiogram cerebral abnormal, Angiogram pulmonary normal, Antiphospholipid antibodies negative, Atrial septal defect, Basilar artery thrombosis, Blood immunoglobulin G normal, Blood immunoglobulin M normal, Drug screen negative, Dysarthria, Echocardiogram, Ejection fraction normal, Facial paresis, Heparin-induced thrombocytopenia test, Hepatitis C test negative, Influenza A virus test negative, Influenza B virus test, Left-to-right cardiac shunt, Magnetic resonance imaging head, Magnetic resonance imaging heart, Platelet count normal, Prothrombin time normal, Pulmonary hypertension, Right atrial dilatation, Right ventricular dilatation, SARS-CoV-2 test negative, Thalamic infarction, Visuospatial deficit
SMQs:, Cardiac failure (broad), Ischaemic central nervous system vascular conditions (narrow), Dementia (broad), Congenital, familial and genetic disorders (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Pulmonary hypertension (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 99999 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: Several months of dyspnea on exertion
Preexisting Conditions: None known. Not overweight. Several months of dyspnea on exertion. Has not visited doctor for 10 years
Allergies: None
Diagnostic Lab Data: CTA Head and Neck 6/3 IMPRESSION: 1. Filling defect within the basilar tip. Posterior cerebral arteries are patent bilaterally. Attenuated flow within the left superior cerebellar artery. 2. No acute intracranial hemorrhage, mass effect, or acute demarcated infarct. 3. No hemodynamically significant stenosis in the neck. Most recent Head without contrast (6/5) IMPRESSION: Evolving right thalamic infarct with mass effect on the third ventricle, slightly enlarged compared to prior CT. No hydrocephalus. No hemorrhagic transformation. SARS-CoV-2 PCR/Swab (COVID-19) negative 6/3 Influenza A/B PCR negative 6/3 Platelets daily from 6/3 - 6/6 -- $g 168, 165, 159, 162 PT/PTT normal on 6/3 and 6/4 anti-cardiolipin IgG and IgM negative 6/4 anti-Beta-2-glycoprotein IgG and IgM negative 6/4 Anti-Heparin (PF4) IgG Antibodies, Optical Density 0.08 (normal) 6/4 Serotonin release assay pending 6/4 Lupus anticoagulant by DRVVT negative (DRVVT ratio 1.06) 6/4 Urine drug screen negative 6/4 Blood culture x 3 preliminarily negative 6/4, 6/5, 6/5 Hep C Ab negative 6/4 Transthoracic echocardiogram with bubble study 6/4 Left Atrium: Normal left atrial size. Bubble study consistent with patent foramen ovale. Following release of Valsalva a small bolus of bubbles is seen entering the left heart. Patent foramen ovale demonstrated with color Doppler. Left Ventricle: Small left ventricular size. Paradoxical septal motion c/w right ventricular volume overload. Normal left ventricular wall motion and ejection fraction. Right Atrium: Severe right atrial dilatation. Right Ventricle: Severe right ventricular dilatation. Normal right ventricular function. Aortic Valve: Normal aortic valve. Mitral Valve: Normal mitral valve. Tricuspid Valve: Normal tricuspid valve. Moderate tricuspid valve regurgitation. Pulmonic Valve: Normal pulmonic valve. Arteries: Normal sized aortic root. Pericardium/Pleura: No pericardial effusion. Hemodynamics: Estimated right atrial pressure is 6-10 mmHg. Mild pulmonary hypertension. Normal LV diastolic function. Ejection Fraction: 70.0 % Lower extremity venous duplex 6/5 Right: The common femoral, femoral and popliteal veins are patent and compressible with normal venous flow patterns. Left: The common femoral, femoral and popliteal veins are patent and compressible with normal venous flow patterns. CTA Chest PE protocol 6/5 (preliminary) **Resident Wet Read** No pulmonary embolism. Right atrial and right ventricular dilation is noted, likely secondary to left to right cardiac shunt in the setting of known PFO.
CDC Split Type:

Write-up: Patient presented 6/3/2021 with thrombus in the top of the basilar artery. Received IV alteplase. Went for mechanical thrombectomy, but catheter angiogram showed resolution of basilar thrombus. He is improving neurologically, currently has some L visuospatial neglect, left lower motor neuron facial weakness and mild dysarthria. He remains hospitalized. This week he will have MRI of brain, cardiac MRI and transesophageal echocardiogram performed. He may have right heart catheterization and closure of the patent foramen ovale.


VAERS ID: 1376456 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Delaware  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033B21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site pain, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Site: Pain at Injection Site-Medium, Site: Redness at Injection Site-Medium, Site: Swelling at Injection Site-Medium


VAERS ID: 1376491 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-06-02
Onset:2021-06-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / N/A LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Injection site pain
SMQs:, Acute pancreatitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient called pharmacy on Thurs 6/3/21 approx. 10:15am to report adverse reaction that she believed to be a result of receiving her COVID vaccine. Patient received Janssen/J&J vaccine (207A21A 06/23/2021; L arm) at our store on Wednesday, 6/2/21. She reported 30 minutes to 1 hour prior to calling us that she started experiencing sharp stomach pain (epigastric region). She denied any history of pancreatitis and has already had her gall bladder removed. I explained that was not one of the common adverse effects from the vaccine, but that it is possible that it could be attributed to the vaccine. I recommended she contact her doctor to see if they want to bring her in and examine her to rule out anything severe that may be going on. If she cannot get in touch with the doctor and the pain becomes severe, I recommended seeking emergency medical help. The only other symptom she had mentioned experiencing was the typical arm soreness at the injection site associated with intramuscular vaccines.


VAERS ID: 1376505 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-06-02
Onset:2021-06-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820096 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye swelling, Mouth swelling, Pruritus, Rash, Swelling face, Swollen tongue
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Allergic: Itch (specify: facial area, extremeties)-Medium, Systemic: Allergic: Rash (specify: facial area, extremeties)-Medium, Systemic: Allergic: Swelling of Face / Eyes / Mouth / Tongue-Medium


VAERS ID: 1376507 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 1 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fall
SMQs:, Anticholinergic syndrome (broad), Accidents and injuries (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient felt dizzy and fell after getting the vaccine. Ice and cold compress was provided for the patient. Patient was aked to wait for about 45 mins for observation.


VAERS ID: 1376528 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product administered at inappropriate site
SMQs:, Drug abuse and dependence (broad), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: N/A
Preexisting Conditions: ASTHMA
Allergies: NOT SURE
Diagnostic Lab Data: UNKNOWN
CDC Split Type:

Write-up: PT CLAIMS THAT VACCINE WAS GIVEN TOO HIGH UP ON THE ARM


VAERS ID: 1376543 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-05-26
Onset:2021-06-03
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Allergic: Rash Generalized-Severe


VAERS ID: 1376549 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Face injury, Fall, Flushing, Hyperhidrosis, Injection site pain, Mouth haemorrhage, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Site: Pain at Injection Site-Mild, Systemic: Dizziness / Lightheadness-Severe, Systemic: Fainting / Unresponsive-Severe, Systemic: Flushed / Sweating-Severe, Additional Details: When patient was given vaccine she appeared calm, She told me she did not like needles. Said she had Tetnus vaccine in recent past and was more anxious about that than she needed to be. Said she had scheduled thios vaccine 1 hour prior and wanted to get it over with. She moved outside vaccine area to seat. Approx. 2 min later,she approached drop off counter,asking for water and said felt faint. She fell and her face hit base of a plastic floor stand. Mouth bleeding,


VAERS ID: 1376553 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Syncope, Unresponsive to stimuli, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Fainting / Unresponsive-Mild, Systemic: Vomiting-Mild, Additional Details: Patient fainted but woke up very quick. Vomitted once the started feeling better. No signs and symptoms of allergic reaction. We called 911 and was checked on site. The 911 personales reported no issue but patient caregiver asked that patient to be checked at the ER.


VAERS ID: 1376555 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Syringe issue, Underdose
SMQs:, Medication errors (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Needle/plunger malfunction, minimal partial dose given due to rest leaking around connection. Full dose repeated 10 minutes later. Patient tolerated injections well, no issues at injection sites.


VAERS ID: 1376557 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8731 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Inappropriate schedule of product administration
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patients first dose received April 13, 2021, 2nd dose received June 3, 2021.


VAERS ID: 1376561 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / UNK RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Product administered to patient of inappropriate age
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Janssen COVID 19 vaccine administered to a patient under the age of 18. Patient had no symptoms.


VAERS ID: 1376595 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8731 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Inappropriate schedule of product administration
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: patients first dose received April 13, 2021, 2nd dose received June 3, 2021


VAERS ID: 1376611 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Axillary pain, Contusion, Dyspnoea, Eye pain, Fatigue, Headache, Nausea, Neck pain, Pain, Somnolence
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Cardiomyopathy (broad), Arthritis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: Fibromyalgia.
Allergies: Morphine, Benadryl.
Diagnostic Lab Data:
CDC Split Type:

Write-up: The first dose gave me a lot of headache, nausea, tiredness, eye pain, body aches, pain in the injection area, a large, hard, itchy red welt, and vertigo. On the second day of the application they say that it has nothing to do but yes, because I did not bring any of that, 2nd dose that was on June 3, 2021 at the time I started with a headache, body, eyes, nausea, tiredness, sleepiness, temperature. On day 4 I was already there that I could not even breathe from the pain so strong that the 800 ibuprofen only calmed the pain for 3 hours and did not take it away completely, that same day I sent a message to my doc where they told me I had to go to the emergency room to help me, but I had no one to take me. By afternoon I could no longer bear the pain in my body, head, eyes, neck, armpits, and I had some bruises. Today the 6th I still have pain, head, body, neck.


VAERS ID: 1376640 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8729 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incorrect product formulation administered, Interchange of vaccine products
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)


VAERS ID: 1376653 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Chills, Dizziness
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Dizziness / Lightheadness-Mild, Systemic: Felt very lightheaded/chills for about 30 minutes. Patient walked out along with her fiancee. she felt back to normal upon getting into they''re car.-Mild


VAERS ID: 1376655 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-01-15
Onset:2021-06-03
   Days after vaccination:139
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, Respiratory tract congestion, Rhinorrhoea, SARS-CoV-2 test positive
SMQs:, Taste and smell disorders (narrow), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: bentyl, codeine
Diagnostic Lab Data: Patient tested positive for Covid 19 infection on 6/6/2021. Symptom onset 6/3/2021. Symptoms included congestion/runny nose and new loss of taste/smell.
CDC Split Type:

Write-up: Patient received 2 doses of Pfizer covid vaccine. Dates: 12/29/2020 and 1/15/2021


VAERS ID: 1376663 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-14
Onset:2021-06-03
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Asthenia, Chest discomfort, Chest pain, Chills, Diarrhoea, Hypertension, Movement disorder, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Abdominal Pain-Severe, Systemic: Chest Tightness / Heaviness / Pain-Severe, Systemic: Chills-Severe, Systemic: Diarrhea-Severe, Systemic: cannot move-Severe, Systemic: Hypertension-Medium, Systemic: Vomiting-Severe, Systemic: Weakness-Severe


VAERS ID: 1376678 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025B21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product administered to patient of inappropriate age
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Error: Patient Too Young for Vaccine Administered


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